Associate Claims Adjudicator Jobs

Providing guidance to internal teams on the claims process and building knowledge and capability.

Benefit from a comprehensive package tailored to your needs, including company-matched RRSPs.

Invest in your future with HUB-sponsored training and development programs. We even offer tuition reimbursement opportunities.

Serve as a trusted advocate for our clients, navigating Personal and Commercial Lines claims with grace and expertise

Provide top-tier technical insights and compassionate advocacy, ensuring our clients feel heard, valued, and supported during their claims journey

Dive into policy wording with a keen eye, analyzing and interpreting the details like a pro to best serve our clients.

Familiarization with the requirements of the appropriate provincial/state legislation and/or regulations related to the type of claim being reviewed.

Perform all necessary benefit calculations and ensure all related activities are in compliance with provincial/state statutory and internal standards.

5 – 7 years experience adjudicating complex claims, including contestable claims;

Knowledge of the interpretation and application of claims adjudication regulations across the United States, knowledge of Canadian regulations an asset

Advanced verbal and written communication skills to effectively communicate with internal and external customers/partners and vendors.

Strong analytical skills for research, review and assessment of claims.

Job Requirements (Education, Experience, Knowledge, Skills And Proficiencies)

You will have adjudication knowledge and experience

Create a white glove customer experience for our Claimants

Manage ongoing claims by requesting further medical, financial documentation or investigations as required and consult with specialists in all areas.

Make decisions on claim benefit eligibility determination and communication decisions to stakeholders

University degree in any discipline or equivalent work experience.

Be responsible for other duties as may be assigned from time to time by Management

Verify data entry for accuracy and completeness

Perform data entry of claims sent to dental consultant is added and confirmed on a spreadsheet

Analytical skills to research review and assess claims

Strong verbal and written communication skills

Strong attention to detail with exceptional organization skills

Review short term disability applications to determine initial eligibility and entitlement to benefits based on medical and contractual requirements

Oversee case until return to work or refer claim internally for case management

Minimum two years experience in a medical, benefits administration, or claims setting; and

Assess functional abilities to determine work-readiness and coordinate suitable return to work

Strong assessment and decision-making skills

Ability to effectively manage and resolve conflict

Knowledge in life insurance and experience in life and disability claims management would be an asset.

Experience related to disability claims management is preferred.

Plan, implement and evaluate sound case management principles.

Knowledge of the insurance benefit industry is considered an asset.

Must possess excellent knowledge and experience with Microsoft Word, Access, Excel, and PowerPoint.

Experience or knowledge with Fineos is an asset.

Familiarization with the requirements of the appropriate provincial/state legislation and/or regulations related to the type of claim being reviewed.

Perform all necessary benefit calculations and ensure all related activities are in compliance with provincial/state statutory and internal standards.

5 – 7 years experience adjudicating complex claims, including contestable claims;

Knowledge of the interpretation and application of claims adjudication regulations across the United States, knowledge of Canadian regulations an asset

Advanced verbal and written communication skills to effectively communicate with internal and external customers/partners and vendors.

Strong analytical skills for research, review and assessment of claims.

Apply strong organizational and time management skills to handle a high volume of claims

Review medical documentation and other evidence to determine the eligibility of workers for compensation benefits

Support people recovering from physical injuries by arranging benefit payments and appropriate treatment

Exhibit excellent interpersonal skills and a high level of professionalism to provide empathic, tactful, respectful, and courteous service

Manage emotionally sensitive conversations while demonstrating a high level of personal resiliency

A minimum of 18 months of experience in making adjudicative decisions and/or applying law and/or policy in the last 5 years

Perform other duties as may be assigned from time to time by Management

Verify data entry for accuracy and completeness

Conduct data entry of claims sent to dental consultant is added and confirmed on a spreadsheet

Knowledge of and the ability to interpret dental codes

Analytical skills to research review and assess claims

Strong verbal and written communication skills